Hospitals and Home Births, According to a Labor and Delivery Nurse

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Home births are more common and popular in different areas of the United States. Honestly, my knowledge of home births is very limited. I am only witness to the ones that don’t go as planned, the ones who show up to the hospital when someone is in distress and action has to be taken quickly to prevent additional harm to mother or baby. As a labor and delivery nurse, it is these situations that send a shiver down my back and makes an uneasy feeling settle in the pit of my stomach. I know that there are many home birth stories out there that have a happy ending. The majority of them probably do. What I do know, having been the nurse who had to act quickly to save a mother or a baby who showed up to the hospital when things at home unexpectedly went south, is that no one wants to deliver a dead baby, or a baby whose brain has been affected because of a lack of intervention, or a delay in appropriate care. Everyone wants a happy, healthy mom and baby.

I think there are probably a lot of women who are good candidates to have one of those happy, healthy home births. I just know I’m not one of them. I was overweight when I got pregnant, I counted every carb that went into my mouth and still ended up gestational diabetic, and then had severe preeclampsia at 35 weeks. Working in labor and delivery, I see how complicated pregnancy and birth has become. I don’t believe the birthing process is complicated, I think the birthing process remains so sweetly simple. But now, women have so many other problems complicating their pregnancy. So many women are overweight, and many women don’t know how this affects their pregnancy and delivery. We see more diabetics, more women with high blood pressure, and more placental abnormalities. There are a lot of other issues that can come up during a pregnancy, and these issues make it dangerous to deliver at home.

Even if you remain completely healthy throughout your pregnancy, the baby might not “come down” because of a short umbilical cord, or a cord that’s wrapped too tightly around its neck or body. The baby could be in a weird position (we call this acynclitic), making it difficult (or impossible) to deliver vaginally. The baby could get trapped (this is called a shoulder dystocia), where the head is delivered and the shoulders are stuck, and then every minute matters to prevent permanent brain damage. And sometimes everyone is surprised with a baby who just does not want to breathe. I can’t count the number of times I’ve seen a baby who was born who unknowingly had a heart defect, making it difficult for them to breathe on their own. Sometimes babies have trouble maintaining their sugar levels, which doesn’t sound like a big deal, but for babies, this messes up everything. And many times, signs of distress are so subtle. All of these things aren’t extremely common, but they do happen. And if there is no intervention, or that intervention is delayed, it could have devastating consequences for everyone. These things could happen to anyone, regardless of how healthy you are, or how many times you have previously delivered a baby vaginally. As a mother, I wouldn’t want to know that a delay in care caused harm to my baby, harm that could have life-long consequences. I don’t want to be responsible for that.

Journey 5

I love the idea of birthing at home. I think it would be so great to be surrounded by familiar things, and not worry about strangers being a part of a process that is so beautiful. I think it would be so incredibly special to experience this with my family. It makes me a little sad knowing that I will never be able to even consider this as an option, because my previous history makes me incredibly high risk. As a labor and delivery nurse, as someone who truly loves the people I take care of, the only thing I can do is focus on how I can change the birthing experience of the people who do decide to have a hospital delivery.

Women should be empowered to make their own decisions, and if a home birth is the right option for you, then I genuinely hope you have the happy, healthy delivery you expect. If you choose to have a hospital birth, know that it can still be special. You can still be surrounded by the people that you love. You still have rights. I want every single woman who decides to deliver in a hospital to know that it remains your body. None of us can do anything to you without your permission. That is a fear that I think drives many women to choose to have a home birth. Talk to different physicians or midwives. Talk to doulas. Talk to other women in your area and find the right option for you. A home birth might be an option for many women out there. But for many more women, it shouldn’t even be considered, and I don’t want any woman out there to let fear of a hospital propel a choice that could completely change your life or the life of your baby.

I am not writing this article to convince a woman to deliver at one place over the other. I want every woman who reads this to make the best decision for themselves and their family. To any woman out there that decides to have a home birth, I hope you have the absolute best experience possible. After all, if you get that, what a wonderful, magical experience that must be! And to any woman who decides to have a hospital birth, I hope you also have an incredible experience. Remember that you have control over what that experience looks like.

Make educated decisions. Remember your rights. As an obstetrical nurse, my ultimate goal is a healthy mother and a healthy baby. Choose what’s best for you, your family, and your pregnancy. And above all, may every single one of you have a healthy pregnancy, labor, and delivery 😃  Regardless of where you decide to have your baby, what a beautiful process we get to be a part of 😃

 

Until my next delivery ❤

 


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Dy
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Dy

Thank you for being honest of your experiences and so focused on a families right to choose what is best for them. A woman should birth where she feels the most comfortable, home or hospital. Most hospital providers are ignorant about home birth. What happens there, what level of monitoring and prenatal care occur. I am a homebirth midwife. I agree that in my approximation 30% of midwives are not properly trained and don’t transfer until you have hit “train wreck potential”. With a well trained, certified and licensed provider the client has many options. I do labs and ultrasounds… Read more »

doulanic
Guest

Thanks for the honest posting! And thank you to Dy for a great commenting post as well – you said everything I was thinking. I’m not a midwife, but am a certified birth doula, I work for midwives, and currently doing my RN refresher training with the intent of working on L+D. I am a huge advocate for home births, when conditions are normal. I’m also from Canada, and I do think there is a big difference here from what you experience in the USA. Here, all midwives are regulated – and the Homebirth candidates are chosen carefully. At the… Read more »

Jos
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I’ve read your blog for a long time, but I honestly don’t know if I’ve ever commented? I always enjoy your posts though. :) Coming out of the wood work to say that I truly believe the more you learn about home birth, the less scary it feels and the safer you will realize it is. I had my daughter in a hospital (30 miles down the road, the closest one to where I live) and my son at home (assisted by a male midwife who has delivered 800+ babies at home over the past 30 years – he is… Read more »

Stacey aka the Soccer Mom
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Interesting perspective, and nice to hear someone from the hospital side who does not automatically put down a non-hospital birth. I attempted natural birth in a certified birthing center with a midwife who came highly recommended. Annabelle had other plans– she was OP and stuck– I was the one who didn’t want to give up, but my midwife insisted after 5 hours of pushing. The intake nurse at the hospital said such cruel things about my midwife, but she did admit that Annabelle was never in danger. After ending up with a c-section, I will have to deliver in a… Read more »

createdfamily
Guest

Working in inpatient mama/baby medicine I’ve been surprised by how many of our L&D and postpartum RNs opt for out of hospital births, then again I live in an area where home birth is becoming more prevalent. While we see the home births gone wrong, we also see so many appropriate and timely transfers of care. It bugs me to no end that these appropriate transfers are documented or talked about as “failed home births.” There is no failure in an out of hospital provider appropriately transferring to a higher level of care when needed! I think Dy’s comment is… Read more »

Momof6
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I think the animosity comes from hospital personnel being perceived as a “2nd choice” for homebirthers. Add in any l & d nurse and ob/gyn’s prior experience with messy transfers with bad outcomes and you get a potentially tense situation. Also, many homebirthers eschew a lot of standard medical procedures which baffles hospital staff. I completely understand how unpleasant birth can be in a hospital setting compared to your own home. Most outcomes are good at home, too – even with women who should have been risked out. But a nursing school classmate of mine was a Certified Professional Midwife… Read more »

momof6
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momof6

I am having a hard time figuring out my account, but I am both momof6 and tlcat625. I’ll figure it out eventually!

Becky
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24 years ago we had our first child. He was born with a diaphragmatic hernia and it was unknown until shortly after his birth. This is my reason for never considering a home birth. Had he not been in a major hospital with neonatal surgeons on call we would not be celebrating his birthday next week. I have many friends who give birth at home or in birth centers and I don’t say anything to discourage them. I just pray that they are blessed with healthy babies and no complications. It is not a given.

Anonymous
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Anonymous

As a labor nurse and mother I would have to say that a healthy mom and baby are, of course, what we all want but there is more to it than that. I hear nurses and docs say that phrase all the time to patients (sometimes leaving our the mom part). I had a terrible experience with my first and really mourned the delivery for a long time and I got so sick of my providers saying, “well, at least you have a healthy baby, that’s all that matters.” Of course women want a healthy baby but that’s not all… Read more »

littlerainbowbug
Guest

Thank you for a thoughtful post on a topic that has people on all sides of it up in arms much of the time! I had a very low risk pregnancy (not a single risk factor outside of smoky being pregnant) and attempted a home birth with a certified direct entry midwife. My little Bug was firmly wedged right side posterior and as worth the vast majority of transfers, I went in for exhaustion and dehydration after 18 hours (pushed out a healthy baby after another 9.5 hours, phwew!). Overall I had a good experience, but I wish so very… Read more »

Anonymous
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Anonymous

As a labor and delivery nurse myself, I thoroughly enjoy your posts! I think you summed it up very well – we want our patients to have the best experience possible, whether that’s a home or hospital delivery. I agree that the regulations of home birth attendants and the lack of oversight is what scares me about home births in my state. With that being said, I have worked with some great providers who did bring their patients to us as soon as a problem occurred that was beyond their capabilities. On the flip side, I have had mothers come… Read more »

safer midwifery utah
Guest

Reblogged this on Ex Natural Childbirth Advocates and commented:
Home birth midwives deliver (comparatively) few babies, and few people see more births than an L&D nurse. Listen to the wisdom in this post- things happen, no matter how healthy you are or what measures you take, and being in a hospital is the best way to deal with the aftermath of a complication.

safer midwifery utah
Guest

Thank you for writing this piece. The most destructive idea I have found in the world of home birth is that if you are just good enough (trust birth enough, follow the right diet, whatever) things will work out.

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